Diaper Dermatitis by mikeholy

VIEWS: 277 PAGES: 20

									               Diaper Dermatitis

Continuity Clinic
   • Be able to identify common infant diaper

   • Understand the factors involved with
     causing irritant diaper dermatitis

   • Know how to treat the common diaper
Continuity Clinic
   • 1990-1997: 4.8 million outpatients visits
      – 75% of these in pediatric offices

   • Peak ages: 9-12 months

   • Often associated with Candida albicans
      – Higher severity associated with C. albicans

Continuity Clinic
     Factors Involved in Development
   • Combination of:
      –   Diaper occulsion
      –   Fecal enzyme activity activity
      –   Urine
      –   Diaper chaging
   • Leads to:
      – Overhydration of the stratum corneum
      – Chemical and mechanical abrasion
      – Susceptibility to penetration of irritants and microbes

Continuity Clinic
          Role of Urine and Feces
   • Interaction of urine and feces is
     fundamental in the development of IDD
     (Irritant Diaper Dermatitis)
   • Bacterial ureases in stool degrade urea in
     urine thus releasing ammonia
      – Ammonia does not irritate skin but increases
        local pH which reactivates fecal enzymes
        such as lipase and protease which irritate skin

Continuity Clinic
               Differential Diagnosis
   • Inflammatory                        • Infectious
      –   Contact Dermatitis                – Candidiasis
      –   Allergic Dermatitis               – Folliculitis
      –   Intertrigo                        – Bullous impetigo
      –   Seborrheic Dermatitis             – Perianal/Intertriginous
      –   Atopic Dermatitis                   streptococcal disease
      –   Psoriasis                         – HSV
      –   Granuloma gluteale infantum       – Scabies
   • Malignancy                             – Congenital Syphilis
      – Langerhans’ cell histiocytosis   • Nutritional/Metabolic
   • Miscellaneous                          – Acrodermatitis enteropathica
      – Miliaria                            – Biotin Deficiency
      – Child Abuse                         – Cystic Fibrosis

Continuity Clinic
   • Irritant Diaper Dermatitis
      – Confluent erythematous papules
      – Scaling
      – Skin Folds Spared
   • Candidiasis Associated
      – Rash > 3 days
      – Irregular, scaly border
      – Satellite lesions
      – Skin Folds involved

Continuity Clinic
        You Guess the Diagnosis!

Continuity Clinic
Continuity Clinic
         Irritant Diaper Dermatitis
                                      Spares skin

Continuity Clinic
Continuity Clinic
                    Candidiasis   Satellite

In folds of

Continuity Clinic
Continuity Clinic
                Bullous Impetigo   Note erosions
                                   of skin

Continuity Clinic
Continuity Clinic
           Streptococcal Intertrigo

Continuity Clinic
             Management of IDD
   • Nonmedical
      – Frequent diaper changes
      – Gentle cleansing
      – Barrier protection

   • Medical
      – Anti-inflammatory  low potency steroids
      – Anti-fungal  lotrimin, nystatin

Continuity Clinic
       Commonly Used Barrier Creams
                              ACTIVE INGREDIENTS
   •   Vitamin A&D ointment   Vit. A & D, lanolin
   •   Aquaphor               Petrolatum, lanolin
   •   Aveeno diaper cream    Zinc oxide, dimethicone
   •   Balmex ointment        Zinc oxide
   •   Boudreaux’s paste      Zinc oxide
   •   Desitin                Zinc oxide
   •   Triple Paste           Petrolatum
   •   Zinc Oxide ointment    Zinc oxide

Continuity Clinic
   • Avoid wipes with alcohol product
   • Nonirritating cleansers: cetaphil or mineral oil
   • Do not entirely wipe away barrier preparation –
     wipe away feces and replace what barrier is
   • Powders?
      – Cornstarch is recommended over talcum powder
      – Talcum powder associated with severe respiratory
        distress caused by inhalation

Continuity Clinic
              Corticosteroid Use
   • Low potency steroids relatively safe
   • Mid to High Potency corticosteroids
      – Generally contraindicated in occluded areas
        of the skin and can cause skin atrophy, striae,
        tachyphylaxis, and growth delay
      – Abraded skin also increases absorption rates

Continuity Clinic

To top